Annie Gilbert Clinical Nurse Specialist Oxford Radcliffe Hospitals NHS Trust

1. Annie GilbertClinical Nurse SpecialistOxford Radcliffe Hospitals NHS Trust Coping with loss and changing eating behaviours following bariatric surgery AUGIS September 2010

2. Surgery is No Panacea • It is well documented that there are certain variables which determine the results of bariatric surgery. In fact some go as far as to say that it is one’s ability to maintain changes that leads to permanent weight loss after surgery rather than the quality of the procedure. (Niego 2007). • By determining which variables effect the weight loss outcomes we can work towards supporting individuals who have undergone surgery to enable them to achieve their weight loss goals. • If we can establish how the individual deal with changing their behaviours we can tailor our practise to meet their needs (Canetti 2009).

3. Model of change The Transtheoretical Model, Prochaska and DiClemente (1983)

4. Denial Referral/diagnosis is not self motivated Case Study: Sally 33yo Roux-en-y gastric bypass 18 months ago Hx Binge Eating pre-operatively, beginning to show signs of binge eating again Precontemplation

5. Definitions of Binge Eating • A binge occurs when a food addict consumes a greater than average amount of food in a specific amount of time. (Greater than average will vary from person to person) • A disorder characterised by repeated episodes of excessive eating (over longer than 6 months) such that the binging does not stop until the person is uncomfortably full. • Binge eating disorder is characterised by a loss of control over eating behaviours. The binge eater consumes unnaturally large amounts of food in a short time period.

6. Contemplation • Self initiated referral • Starting to considered there is an issue • Event/incident • Potential to stop here and relapse • Recognising lack of control • Barriers: socioeconomics, culture, education, understanding. • Consider- is individual aware that effort is needed? Consider health beliefs.

7. The Health Belief model Becker et al , (1984)

8. Preparation • What to do about it? • Forming plans • Seek professional help, WW/SW, fad diets, counselling, CBT, hypnosis • Has self awareness- does the individual have ability to change awareness into action? • Starting to feel in control

9. Action • Start making changes • Motivated • Feels in control • Starting to see results

10. Relapse • Can happen at anytime • Loss of control • Maladaptive eating patterns • Anxiety • Depression • Pre-operative demand for food in emotional situations, so in a situation where volume of food is restricted can contribute to emotional alterations such as anxiety and depression (Zilberstein 2009).

11. Weight regain • Related to inability to change habits rather than surgery. “I Expected that it would become easier to choose what to eat; that I would be able to choose the sandwich instead of the chocolate… I thought that I would be able to manage it easily…” (Zijlstra et al 2008) “I know I should be eating those tiny meals but my brain actually wants to eat more- I miss big meals…” Sally 2010 • Consider contemplation and health beliefs; When interviewing individuals who have undergone WLS yes/no answers 46% feel they could loose weight if they change eating behaviours (54% don’t!) 17% feel exercise will help them to loose weight, 83% don’t. (Pinto 2009) These statistics illustrate sensations of lack of control and self efficacy.

12. Implication for practice • To improve treatment we must identify variables which predict weight loss outcomes. • Model of change helps provide a theoretical insight into the change process and may help to facilitate customised programmes so individuals with disordered eating are not necessarily discounted for surgery (Gorin and Raftopoulos 2008).

13. References Canetti L et al. Psychosocial Preditors of Weight Loss and Psychological Adjustment Following Bariatric Surgery and a Weight Loss Programme: The Mediating Role of Emotional Eating. International Journal of Eating Disorders. 2009. 42:2 109-117 Chesler B, et al. Implications of Emotional Eating Beliefs and Reactance to Dietary Advice for the Treatment of Emotional Eating and Outcome Following Roux-en-y Gastric Bypass: A Case Report. Clinical Case Studies. 2009 8:277-295 Gorin A, Raftopoulos. Effect of Mood and Eating Disorders on the Short Term Outcome of Laparoscopic Roux-en-y Gastric Bypass. Obesity Surgery. 2008. 19:1685-1690 Janz N, Becker M. The health Belief model: A Decade Later. Health Education Quarterly. 1984. 11: 1-47 Madan A, Beech B, Tichansky D. Eating patterns in Patients undergoing Bariatric Surgery. Conference Abstract. 2009. Niego S et al. Binge Eating in the Bariatric Surgery Population: A Review of the Literature. International Journal of Eating Disorders. 2007. 40:4 349- 359. Pinto L et al. Study of Factors Related to the Regaining of Weight in Patients Submitted to Bariatric Surgery. Conference Abstract 2009 Rusch M, Andris D. maladaptive eating Patterns after weight loss surgery. Nutrition in Clinical Practise. 2007. 22:41-44. Zilberstein B et al. Compulsive Behaviour After Bariatric Surgery. Conference Abstract. 2009 Zjlstra H et al. Patient’s Explanations for Unsuccessful Weight Loss After Laparoscopic Adjustable Gastric Banding. Patient Education and Counselling. 2009. 75 108-113.